Recurring patella dislocation in competitive gymnast - help

hi ....
i have written here before .. all but a year ago when that nasty moment on whilst trampolining changed my life and apparently my knee forever ...

17th april 2009 first patella dislocation. Landed awkwardly in twisting motion ... 10 hours later knocked out and doctors put it back .... ( after alot of trouble ) .... and consequently within the next few days it had dislocated again ... i put it back ( i was on alot of pain killers anyway )
i was cast for a while... then splinted... and the extensor mechanism was completely errm NOT working... infact you could see the massive whole accross my ( one good quadrasep ) where it wasnt connecting....Feb 2010 ... " it's not right" says the DR ... Arthroscopy ... kneecap damaged underneath .. dr fixed that...

one year later ..

17th april 2010 ... finally i am back at trampolining and gymnastics ....handspring on track .. ( simple move ) ... landed ...felt that snapping motion ... knee dislocated i fell on floor ... before i had time to even think i had instinctively grabbed the offending leg and pulled it out straight and felt that relieveing "pop" as it slid back in......i got up kept it moving.. walkd on it for a bit.. and one week later i can walk normally again ...

BUT its grating on extension/flexion .... oh i cant actually straighten it? ... ( im normally hypermobile in the knee joint ... i cant even get it 180 degree straigt now...)

anyway .. i need your help ! ... a year of physio hasnt helped... had hydro therape too ... a year off training hasnt helped ... that arthroscopy to scrape the kneecap hasnt helped... WHAT CAN I DO ? .. i mean this is a MASSIVE problem ... my coach is thinking that i cant compete anymore because of it ... and gymnastics is my life.. its all i know :(

anybody got a miricale cure out there ? ... i just want it to go back to the way it was b4 it dislocated ... and never to dislocate again !

thanks for looking
:(

Hi Tristan_Mei-Ling

You are not going to like my response but I think it is most near the truth

It sounds like this is now a repeated situation. Each time your knee dislocates you are likely to further damage the cartilage, strain the extensor mechanism, stretch the medial reticulation and related muscle. You must have seriously damaged the cartilage. An arthroscopic repair can clean things up but it is never the same.

You should be aware that if you continually put the knee at risk of further dislocation then you may end up down a path of increasing disability. this could end up affecting not just your sport but just getting around.

There is no cure. If you have been receiving good rehabilitation for the knee and the problem is still recurring then you must have considerable damage. It is one thing to have a knee that can function in everyday life, but it is another thing when you are putting the demands on the knee involved in competitive gymnastics.

I am sure this is not what you want to hear. However I think it is pointless putting up false hope.

For your own peace of mind I would suggest you consult an orthopaedic surgeon who specialises in such knee injuries - maybe someone who is well known in the gymnastic world. Get a second opinion on this. The surgeon will be able to give you an unbiased opinion on the prognosis of your knee. If there is anything that can be done surgically he/she should be able to fill you in on the options. However you need to be aware about the limitations of surgery - no surgical procedure will turn back the clock. If the surgeon thinks there is some hope then you can follow that path. But if not it may be better to face up to what has happened and get some help to come to terms with it and move on.

Have you talked to an orthopaedic specialist/sports physician about surgical procedures to stabilise the patella?:( this may involve tightening up the damaged retinaculum (one of the the structures that holds the patella in place). This is different to the arthroscopic repairs that you had done as these involve structures inside the capsule of the knee joint

Have you tried wearing a patella stabilizing brace as well as lots and lots of quadriceps exercises that emphasise activation of the medial vastus? (and then some more).

You may well have a very shallow groove for the patella to fit into in which case even surgery wouldn't achieve patella stability.

If you have exhausted all of these avenues then a period of rest/recovery may be mandatory. Maybe you could think of an alternate sport like diving that uses similar skills.